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DESIGNATED c <br />MONTHLY• <br />Facility Name <br />Olympian # 427 <br />Date July 18, 2007 <br />Facility Address <br />3300 Waterloo Road <br />City, State, Zip <br />Stockton, CA 95205 <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Designated Operator <br />Copp, Gregory <br />ICC Certification # <br />5278409 -UC <br />Expiration February 16, 2008 <br />Signature <br />Sump Location: Gasoiline - 87 5 9 Sump Location: <br />Phone (916) 826-3082 <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Y N <br />Y <br />N <br />Sump Location: Gasoiline - 87 5 9 Sump Location: <br />9 <br />9 <br />Sump Location: 9 9 Sump Location: <br />9 <br />9 <br />Sump Location: 9 9 Sump Location: <br />9 <br />9 <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y <br />N <br />NA <br />Tank 1- Gasoline -87 5 9 9 Tank 3- Diesel <br />5 <br />9 <br />9 <br />Tank 2- Gasoline -89 5 9 9 <br />9 <br />9 <br />9 <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y <br />N <br />NA <br />Dispenser 1 5 9 9 Dispenser 7 <br />5 <br />9 <br />9 <br />Dispenser 2 9 5 9 Dispenser 8 <br />5 <br />9 <br />9 <br />Dispenser 3/ 4 5 9 9 Dispenser 9/ 10 <br />5 <br />9 <br />9 <br />Dispenser 5/ 6 5 9 9 Dispenser 11 / 12_......_....._.... <br />5 <br />9 <br />9 <br />©2007 �-,----- Page Checklist P1 <br />